Provider Demographics
NPI:1689870057
Name:COOMER ENTERPRISES
Entity Type:Organization
Organization Name:COOMER ENTERPRISES
Other - Org Name:HERTIAGE HILLS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:COOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-866-3622
Mailing Address - Street 1:PO BOX D
Mailing Address - Street 2:HWY 72
Mailing Address - City:PATTON
Mailing Address - State:MO
Mailing Address - Zip Code:63662-0057
Mailing Address - Country:US
Mailing Address - Phone:573-866-3622
Mailing Address - Fax:573-866-0054
Practice Address - Street 1:PO BOX D
Practice Address - Street 2:HWY 72
Practice Address - City:PATTON
Practice Address - State:MO
Practice Address - Zip Code:63662-0057
Practice Address - Country:US
Practice Address - Phone:573-866-3622
Practice Address - Fax:573-866-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031765310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility